HomeMy WebLinkAbout427 Lopez Ave - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DMSION
321 EAST 5TI1 STREET, PORT ANGELES, WA 98362
PUBILIC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
WINIFRED OSTRAND
427 LOPEZ
Port Angeles, W A 98362
000/600-0000
PROJECT INFO
Work is
Plans Required Start Date
Contractor' ANGELES PLUMBING
Performance Bond Required Amount:
Proof of Insurance
Work to Perform
Issued
11127/2001
Perm it No
Work Order'
1220
o
PROPERTY LOCATION
427 LOPEZ
Lot: 17
Subdivision
Parcel No
Block. 17
PSCC 2ND ADD
063010501772000
~ Long Legal
Value Work.
$000
1 1
Finish Date
360/452-8525
1 1
$000
o Install
~ Repair
o Watermain
~ Sanitary Sewer
o Storm Drain
o Underground Tele/Elec
o Misc
PROJECT NOTES
repair existing san. sewer
FEES ASSESSMEN'F
1 ) R/W Excav' $45.00 15 ) Other San Sewer' $000
2.) Sidewalk. $000 16) Sew Tap Wye/Man Tap $000
3 ) Curb/Gutter' $000 17) Sew Capl W/M Removal $000
4 ) Driveway' $000 18 ) Alter Repair Sewer' $000
5 ) Dwy Culvert: $000 19 ) Storm Drain. $000
6 ) Street Cut: $230 00 20 ) Catch Basin per ea $000
7 ) Other R/W $000 21 ) Sewer System Dev' $000
8 ) Fire Hydrant: $000 22.) Milwaukee Dr Sew Ass. $000
9) Res Water Servo $000 23 ) R/W Use Perm $0.00
10) Comm Water Servo $000 24 ) Admin Cost (D RA) $000
11 ) Other Water Service. $000 25 ) D RA. $000
12.)Water System Dev' $000 26 ) Misc: $000
13 ) San Sewer SFR $000 TOTAL FEE. $275.00
14) San Sewer MFR $000
add unit: 0 Amount Paid $275 00
Receipt No
Inspection Fee $000 Balance Due. $0.00
RW SANITARY WATER DWY STORM DRA OTHER
Separate Permits are required for electrical work, utilities, private and pUblic improvements. This permit becomes null and void if work or
construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that J have
read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any state or local law regulating construction or the performance of construction.
[J,j}A~~ //77)(
Signature of Contractor Authorized Agent Date Signature of Owner (if owner is builder) Date
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST
Date/"2- 5 - () I
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection one No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
S-Pzu&7C-
INSPECTION NOTES ____----..-..
Inspected Date I ;:;l - '3 - 0 I Time It IV! By ~
Remarks R 0 "'" ^ "(2 cl 7,.f b COO'lr. r-e pw('@.rf 1.1: n t....1' VC
L..l>"'c.. '~)~S e>1"",!?pq ,^,.1~ t-ao-rs-
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RESTORATION REQUIRED. .
YES X NO
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SURFACE RESTORATION ( ~ K g J
SURFACE TYPE 0 Unimproved 0 Gravel 00 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
54 COMPLETE 1d--a4-~\ \\~y
b' INCOMPLETE
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